The Relationship Between Agency Characteristics and Quality of Home Care

ABSTRACT. Background. This project assessed the relationship between home care quality indicators HCQIs) and agency characteristics. Methods. Twelve agencies completed a mailed survey on a variety of characteristics, including size of their caseload and for-profit (FP) status of contracted service providers. The HCQIs were derived from standardized assessments completed voluntarily for home care clients in Ontario and in Manitoba, Canada. Results. The average caseload was 121.3 clients per case manager, and over 40% of nursing, personal support and therapy providers were considered FP. For individual HCQIs, few correlations were statistically significant. An overall summary measure of quality was correlated with the size of the population served (r = _0.80; p \u3c 0.05) and the number of clients per case manager (r = _0.56; p \u3c 0.1). Conclusion. These data represent unique information on home care quality and organizational characteristics in Canada. The question remains as to how best to use HCQI data to inform practice in an era of limited resources and increasing caseloads

The health and well-being of older adults with dual sensory impairment (DSI) in four countries

Objectives Dual sensory impairment (DSI) is a combination of vision and hearing impairments that represents a unique disability affecting all aspects of a person’s life. The rates of DSI are expected to increase due to population aging, yet little is known about DSI among older adults (65+). The prevalence of DSI and client characteristics were examined among two groups, namely, older adults receiving home care services or those residing in a long-term care (LTC) facility in four countries (Canada, US, Finland, Belgium). Methods Existing data, using an interRAI assessment, were analyzed to compare older adults with DSI to all others across demographic characteristics, functional and psychosocial outcomes. Results In home care, the prevalence of DSI across the four countries ranged from 13.4% to 24.6%; in LTC facilities, it ranged from 9.7% to 33.9%. Clients with DSI were more likely to be 85+, have moderate/severe cognitive impairment, impairments in activities of daily living, and have communication difficulties. Among residents of LTC facilities, individuals with DSI were more likely to be 85+ and more likely have a diagnosis of Alzheimer’s disease. Having DSI increased the likelihood of depression in both care settings, but after adjusting for other factors, it remained significant only in the home care sample. Conclusions While the prevalence of DSI cross nationally is similar to that of other illnesses such as diabetes, depression, and Alzheimer’s disease, we have a limited understanding of its affects among older adults. Raising awareness of this unique disability is imperative to insure that individuals receive the necessary rehabilitation and supportive services to improve their level of independence and quality of life

The Role of Medications in Predicting Activity Restriction Due to a Fear of Falling

Objectives: To examine the role of medication use and other factors in predicting activity restriction due to a fear of falling (AR/FF). Methods: Older adults were assessed twice with the interRAI Community Health Assessment and the Berg Balance Scale (BBS). The main outcome was limiting going outdoors due to an AR/FF. Medications were recorded by trained assessors. Results: Participants (n=441) had a mean age of 80.3 (sd=7.1) years, most were aged 65+ (96.8%) and 29.3% reported activity restriction. Taking nervous system active or cardiovascular medications was associated with AR/FF. In a multivariate model, the main predictors were having 3+ comorbid health conditions, lower (i.e., worse) scores on the BBS, having difficulty with climbing stairs, and having a visual impairment. Discussion: Modifiable risk factors, related to functional impairments, such as difficulties with balance and vision, appear to be more important predictors than medications

Addressing Health Care Needs For Frail Seniors In Canada: The Role of InterRAI Instruments

Fiscal pressure on the Canadian health care system results from rising numbers of frail seniors with multiple concurrent medical co-morbidities and geriatric syndromes. Improving outcomes in such seniors is contingent on a comprehensive geriatric assessment (CGA) to identify strengths and deficits and to facilitate the development of a comprehensive care plan. InterRAI instruments are standardized, reliable, and validated suites of tools to conduct CGAs; they offer several benefits, including helping clinicians identify important health issues among patients, develop appropriate care plans, and monitor patient progess. These instruments also provide several benefits beyond the bedside, including quality indicators to assess care quality, and case-mix classification algorithms to facilitate funding of health services. Finally, interRAI instruments, which are implemented in several health care settings across Canada and abroad, provide a standardized and common language that is compatible with electronic medical records and will facilitate greater integration of the health care system

Pengaruh Kombinasi Senam Kaki Dan Aromaterapi Terhadap Abi Dan Tingkat Stres Pada Penderita DM Di Puskesmas Jajag

Ankle Brachial Index (ABI) merupakan salah satu pemeriksaan dini pada untuk mengetahui insufisiensi arteri sebagai salah satu komplikasi dari diabetes mellitus. Dimana insufisiensi arteri merupakan keadaan pembuluh darah yang berkurang aliran darah yang berakibat iskemia jaringan. Selain itu pada pasien dengan diabetes mellitus juga dapat timbul permasalahan stress sebagai dampak dari penyakit menahun yang dialami. Salah satu metode penatalaksanaan kedua kondisi diatas adalah kombinasi senam kaki diabetic dengan aroma terapi. Penelitian ini bertujuan menganalis pengaruh kombinasi senam kaki dan aromaterapi terhadap ankle brachial index dan tingkat stres pada penderita diabetes mellitus. Penelitian ini menggunakan desain pre and post test group design with control group. Populasi penelitian ini pasien di wilayah kerja Puskesmas Jajag . Tehnik sampling purposive sampling dengan besar sampel 32 orang. Alat pengumpulan data kuesioner dan observasi, dianalisa dengan uji wilcoxon. Keputusan diambil dengan membandingkan nilai probabilitas p value < 0.05. Hasil penelitian menunjukkan uji Wilcoxon ada pengaruh senam kaki dan aromaterapi terhadap nilai ABI dengan p value 0.004 dan ada pengaruh senam kaki dan aromaterapi terhadap tingkat stress dengan p value 0.001. Senam kaki adalah kegiatan atau latihan yang dilakukan oleh pasien DM untuk mencegah terjadinya luka dan membantu melancarkan peredaran darah bagian kaki. Senam kaki dapat memperbaiki sirkulasi darah dan mencegah terjadinya kelainan bentuk kaki. Sementara itu Aroma terapi dengan menggunakan minyak essensial yang dinilai dapat membantu mengurangi bahkan mengatasi gangguan psikologis dan gangguan rasa nyaman seperti cemas, stress, depresi, dan sebagainya Untuk meningkatkan nilai abi maka diharapkan pasien untuk rutin melakukan senam kaki diabetic. Sementara itu untuk meningkatkan relaksasi dan menurunkan tingkat stress, pasien diabetes mellitus dapat melakukan aktifitas aroma terapi

Use of the interRAI CHESS Scale to Predict Mortality among Persons with Neurological Conditions in Three Care Settings

Background: Persons with certain neurological conditions have higher mortality rates than the population without neurological conditions, but the risk factors for increased mortality within diagnostic groups are less well understood. The interRAI CHESS scale has been shown to be a strong predictor of mortality in the overall population of persons receiving health care in community and institutional settings. This study examines the performance of CHESS as a predictor of mortality among persons with 11 different neurological conditions. Methods: Survival analyses were done with interRAI assessments linked to mortality data among persons in home care (n = 359,940), complex continuing care hospitals/units (n = 88,721), and nursing homes (n = 185,309) in seven Canadian provinces/territories. Results: CHESS was a significant predictor of mortality in all 3 care settings for the 11 neurological diagnostic groups considered after adjusting for age and sex. The distribution of CHESS scores varied between diagnostic groups and within diagnostic groups in different care settings. Conclusions: CHESS is a valid predictor of mortality in neurological populations in community and institutional care. It may prove useful for several clinical, administrative, policy-development, evaluation and research purposes. Because it is routinely gathered as part of normal clinical practice in jurisdictions (like Canada) that have implemented interRAI assessment instruments, CHESS can be derived without additional need for data collection.Public Health Agency of Canada, Project #6271-15-2010/3970773, Ontario Home Care Research and Knowledge Exchange Chair (to JPH) through the Ontario Ministry of Health and Long Term Car

Reliability of Standardized Assessment for Adults who are Deafblind

This study assessed the reliability of the interRAI Community Health Assessment (interRAI CHA) and Deafblind Supplement (DbS). The interRAI CHA and DbS represents a multidimensional, standardized assessment instrument for use with adults (18 and older) who are deafblind. The interrater reliability of the instrument was tested through the completion of dual assessments with 44 individuals who were deafblind in the province of Ontario, Canada. Overall, nearly 50% of items had a kappa value of at least 0.60, indicating fair to substantial agreement for these items. Several items related to psychosocial well-being, mood, and sense of involvement had kappa scores of less than 0.40. However, among these items with low kappa values, most (78%) showed at least 70% agreement between the two assessors. The internal consistency of several health subscales, embedded within the assessment, was also very good and ranged from 0.63 to 0.93. The interRAI was also very good and ranged from 0.63 to 0.93. The interRAI CHA and DbS represents a reliable instrument for assessing adults with deafblindness to better understand their needs, abilities, and preferences

Uma Análise das Condições de Oferta de Cursos de Graduação a Distância nas Instituições Federais de Ensino Superior

O avanço tecnológico e a globalização da educação e da informação têm trazido novos rumos às IFES (Instituições Federais de Ensino Superior). A sociedade está se adaptando às novas tecnologias e aos efeitos da globalização e vem cobrando destas instituições novas atitudes, novos modelos de planejamento e apresentando novas demandas. Um dos principais desafios atualmente enfrentados pelas IFES é o oferecimento de cursos de graduação a distância. As poucas iniciativas existentes na área de ensino a distância no Brasil encontram-se ainda em fase inicial de pesquisa e desenvolvimento. Nas IFES, estas iniciativas têm sido muito tímidas. Pode-se dizer que a consolidação desta modalidade de educação beneficiaria grupos sociais que, normalmente, não são atingidos pelo sistema de educação clássica. As IFES não podem mais fugir ao compromisso social de serem instrumentos para promover a educação. O ensino a distância é uma realidade que provoca mudanças e novas atitudes e as IFES não podem deixar de considerar esta nova modalidade de ensino. O ensino a distância poderia impulsionar a atuação das IFES. Porém, este novo contexto exige das IFES uma nova postura em relação à gestão administrativa e pedagógica para o oferecimento de cursos de graduação a distância. Este artigo apresenta alguns questionamentos sobre esta nova postura que as IFES deveriam assumir. Apresenta, também, discussão sobre projetos pedagógicos de cursos a distância. Uma das principais conclusões diz respeito à falta de flexibilidade das IFES em termos de infra-estrutura física e administrativa para o oferecimento de cursos de graduação a distância. Conclui-se também, que a crescente evolução das tecnologias de informação e de comunicação requerem agilidade administrativa para que sejam prontamente incorporadas nestes cursos. Ainda outra conclusão diz respeito à necessidade de novas habilidades por parte do corpo administrativo das IFES, para poderem utilizar efetivamente as tecnologias de informação e de comunicação imprescindíveis nos cursos a distância

Diagnostic data for neurological conditions in interRAI assessments in home care, nursing home and mental health care settings: a validity study

Background: The interRAI suite of assessment instruments can provide valuable information to support person-specific care planning across the continuum of care. Comprehensive clinical information is collected with these instruments, including disease diagnoses. In Canada, interRAI data holdings represent some of the largest repositories of clinical information in the country for persons with neurological conditions. This study examined the accuracy of the diagnostic information captured by interRAI instruments designed for use in the home care, long-term care and mental health care settings as compared with national administrative databases. Methods: The interRAI assessments were matched with an inpatient hospital record and emergency department (ED) visit record in the preceding 90 days. Diagnoses captured on the interRAI instruments were compared to those recorded in either administrative record for each individual. Diagnostic validity was examined through sensitivity, specificity and positive predictive value analysis for the following conditions: multiple sclerosis, epilepsy, Alzheimer's disease and other dementias, Parkinson's disease, traumatic brain injury, stroke, diabetes mellitus, heart failure and reactive airway disease. Results: In the three large study samples (home care: n = 128,448; long-term care: n = 26,644; mental health: n = 13,812), interRAI diagnoses demonstrated high specificity when compared to administrative records, for both neurological conditions (range 0.80 - 1.00) and comparative chronic diseases (range 0.83 - 1.00). Sensitivity and positive predictive values (PPV) were more varied by specific diagnosis, with sensitivities and PPV for neurological conditions ranging from 0.23 to 0.94 and 0.14 to 0.77, respectively. The interRAI assessments routinely captured more cases of the diagnoses of interest than the administrative records. Conclusions: The interRAI assessment collected accurate information about disease diagnoses when compared to administrative records within three months. Such information is likely relevant to day-to-day care in these three environments and can be used to inform care planning and resource allocation decisions.Public Health Agency of Canada. In addition, Dr. Hirdes’ participation is supported through the Ontario Home Care Research and Knowledge Exchange Chair funded by the Ontario Ministry of Health and Long Term Care. Dr. Marrie is supported, in part, by a Don Paty Career Development Award from the MS Society of Canad